Provider Demographics
NPI:1295839256
Name:SRF INC
Entity Type:Organization
Organization Name:SRF INC
Other - Org Name:HAWTHORNE PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH./PRES
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:541-773-5345
Mailing Address - Street 1:600 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6706
Mailing Address - Country:US
Mailing Address - Phone:541-773-5345
Mailing Address - Fax:541-779-7293
Practice Address - Street 1:600 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6706
Practice Address - Country:US
Practice Address - Phone:541-773-5345
Practice Address - Fax:541-779-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
ORRP00003183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR149443Medicaid
2077344OtherPK
1310770001Medicare NSC